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For men and women alike, the leading cause of death in the U.S. is coronary heart disease, according to the American Heart Association (AHA)—specifically, heart attacks and other problems resulting from clogged arteries.

But you may be surprised to learn how dramatically a person’s risk of a heart attack can be cut by controlling four risk factors.

Cigarette smoking is the first. As many as 30 percent of all coronary heart disease deaths are caused by cigarette smoking, says the AHA. The more you smoke, the higher your risk. The risk is particularly high for women smokers who take oral contraceptives.

Studies also show that within 15 years of quitting, the risk of heart attack declines to levels similar to the risk for people who never smoked. True, quitting can be difficult, but a variety of effective treatments and programs are now available. These include the nicotine skin patch (this seems to work best when accompanied by behavior modification techniques), hypnosis, acupuncture, aversion therapy and counseling by a clinician.

A high level of cholesterol in the blood is another powerful risk factor for heart disease. The recommendation of the National Cholesterol Education Program is to lower total cholesterol to less than 200 milligrams per deciliter of blood, with an optimal LDL level no more than 100, triglycerides no higher than 150, and HDL levels at 40 or above. The best way to accomplish this is to eat a diet low in saturated fat. However, if your high cholesterol level is hereditary, dietary changes alone may not lower it enough; in that case, talk to your healthcare provider about medication.

The higher your blood pressure, the higher your risk of a heart attack. While high blood pressure has no symptoms and no early warning signs, it can be detected simply and quickly in your healthcare provider’s office. High blood pressure can be treated with medication and changes in your lifestyle. These changes might include weight loss, regular exercise and salt reduction in your diet. Only your doctor can assess which method is best for you. Often an approach that combines medication with lifestyle changes is used to control high blood pressure.

Exercise is another way to substantially reduce the risk of coronary heart disease. One study analyzed the impact that exercise had on the life expectancy of 10,269 Harvard alumni. The study found that beginning moderately vigorous sports activity in middle age or old age was associated with a 23 percent lower risk of death.

The best place to begin managing your risk for coronary heart disease is in your healthcare provider’s office. He or she can begin by measuring your blood cholesterol level and blood pressure, evaluating your capacity to begin exercising and offering advice on how to quit smoking. Your doctor’s involvement is vital. But once you and your doctor have agreed on how to manage your heart disease risk, your involvement becomes crucial as well. Because, while heart disease often can be prevented, only you can do the preventing.